Hi, I’m Nick Ortiz. I’m a board certified disability insurance attorney.
Today I’m here to talk to you about Berkshire Life Insurance Company of America. Now Berkshire Life is a wholly-owned subsidiary of The Guardian Insurance Company of America. So for the purposes of this video, when you hear me refer to Guardian Life, I’m going to be using Guardian Life in place of Berkshire Life because in all likelihood, any correspondence you’re getting from the insurance company will have Guardian letterhead.
More specifically, we’re here today to talk about the reasons why Guardian Life may have denied a disability insurance claim and what you can do about it. So I’m gonna go over some of the key reasons why Guardian Life denies insurance claims, but this isn’t gonna be all encompassing in identifying every single type of reason they might give, just some of the more common ones.
So perhaps one of the most common ones is that they say that there is insufficient objective medical evidence to support the claim. What are objective medical findings? That’s things like x-rays, MRIs, CT scans, ultrasounds. They want to see that there’s positive findings with that type of test. But the problem is there are certain types of conditions that aren’t conducive to having objective findings. So for example if someone has a severe fibromyalgia condition, then objective tests like an x-ray isn’t necessarily going to identify what’s causing the pain underlying the fibromyalgia. So you can counter the argument of lack of objective findings by showing the impairments that you have as a result of your medical condition through things like functional capacity testing, physical exams performed by your doctor, pressure point tests and thing like that. My point is there are certain things that can be done to counter the argument that there is insufficient objective medical findings.
Another common reason why Guardian Life may deny claims is because they say that there’s insufficient evidence of a functional impairment. What does that mean? In short, it means that although you have medical records and even you may have x-rays and things like that, they’re gonna argue that that doesn’t necessarily indicate why it is you can’t perform work activity. Functional impairment means your inability to lift over 10 pounds, or your inability to bend, stoop, twist, crouch, or crawl. They want to see evidence of a condition that’s expected to limit you in those types of areas. And that’s what functional impairment is. So if you have any evidence that goes to show your level of functional impairment: maybe some opinions from your treating physician, or if you’ve undergone a functional capacity evaluation in itself to measure those things, then that is one way to counteract that type of denial.
Another example, reason for denying a claim is, let’s say that someone had primarily a sedentary job which is a desk job. And they say that we think you can perform sedentary work and therefore you’re no longer disabled. But the problem is maybe they didn’t take into account the cognitive requirements or the thinking requirements of that type of job. So even if one is able to sit for most of the day, if you have a condition that really limits the ability to think, let’s say someone’s an accountant, or a doctor, and the pain is so significant that it distracts and impairs your ability to maintain the thinking requirements of the job, then the mere ability to sit is not a good reason for a denial. So we make cognitive arguments in some of our cases as well.
And finally, another reason why they might deny a claim is that they say that your doctors are no longer filling out forms for you. And that may be as a result of the insurance company requesting too much information. In our opinion, the insurance companies really try to drive a wedge between you and your doctor by constantly requesting updated medical records. And fill out this form and fill out that form. And they’re calling them trying to get the doctor on the phone. Eventually the doctor’s office gets kind of tired of dealing with the insurance company, so they tell the insured, you, that they’ll no longer fill out paperwork. Well then the insurance company uses that against you to say you’re no longer disabled as evidenced by the fact that your doctor is not filling out any more paperwork. Well just because the doctor is frustrated with the insurance company, that doesn’t mean that you’re no longer disabled. So you can take actions to counteract that as well.
My point is that you have to identify the reasons why Guardian Life has denied your claim, and then specifically address each of those things in your response in your appeal.
Our office has lots of experience in going against the Guardian and fighting against the reasons why they deny people or terminate benefits. So if you’d like to contact us for a free case evaluation if your case has been denied, then I encourage you to call us at 850-898-9904. Or if you’d like additional written material, I have a book called “The Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim.” I’m making that available for a free download at www.freeltdbook.com. So please visit there and we look forward to hearing from you.